Knowledge, motivation and barriers to diabetes control in adults in Jamaica / Conocimientos, motivación, y obstáculos en relación con el control de la diabetes de adultos en Jamaica

In this descriptive study, individual structured interviews were conducted on a random sample of 35 men and 98 women from a population (n = 510) of clinic patients. Open questions sought to determine the extent of knowledge, motivation and barriers to lifestyle changes for control of diabetes mellitus (DM) in Jamaican adults. These were coded into themes and described. Other data were analysed using SPSS. Men (61.8 +/- 14.8 years) were older than women (54.9 +/- 13.7 years) and demonstrated less knowledge (p = 0.006). The respondents (71%) indicated the need for more education. Barriers to lifestyle changes and glycaemic control included a low education level (64%), inadequate knowledge (80%), lack of perceived risk (80.4%) and lack of self-monitoring (93%). Only 23% were controlled to HbA1c < or = 6.5%. The patients' reference to the physicians as a primary source of information indicated the need for a collaborative team approach, and the incorporation of diabetes education as an indispensable service at this clinic.

En este estudio descriptivo, se realizaron entrevistas estructuradas individuales a una muestra aleatoria de 35 hombres y 98 mujeres de una población (n = 510) de pacientes clínicos. Las preguntas abiertas buscaban determinar la extensión de los conocimientos, la motivación, y los obstáculos a los cambios en el estilo de vida para el control de la diabetes mellitus (DM) en adultos jamaicanos. Estas fueron codificadas en forma de temas, y descritas. Otros datos fueron analizados usando el paquete estadístico SPSS. Los hombres (61.8 ±14.8 años) fueron mayores que las mujeres (54.9 ± 13.7 años) y demostraron menos conocimientos (p = 0.006). Los respondientes (71%) indicaron la necesidad de más educación. Los obstáculos a los cambios en el estilo de vida y el control glicémico, incluyeron un bajo nivel educacional (64%), conocimientos inadecuados (80%), falta de percepción de riesgos (80.4%) y falta de auto-monitoreo (93%). Sólo el 23% se mantenían bajo un control de HbA1c # 6.5%. La referencia de los pacientes a los médicos como fuente primaria de información indicó la necesidad de un enfoque colaborativo en equipo, y de la incorporación de la educación para la diabetes como un servicio indispensable en esta clínica.

Self-care, compliance and glycaemic control in Jamaican adults with diabetes mellitus / Autocuidado, cumplimiento y control glicémico en los adultos jamaicanos con diabetes mellitus

Appropriate self-care practices, including nutrition and medication compliance, are essential to satisfactory control of diabetes mellitus (DM). This descriptive study assesses self-care practices, and their relationships to glycaemic control in adults with DM in Jamaica. A pre-tested structured interview and anthropometric measurements were carried out on 98 women and 35 men, randomly selected from a population (n = 510) of adult clinic patients. HbA1c was used as the index of glycaemic control. Self-care practice scores indicated the extent of compliance with appropriate lifestyle practices. Data were analyzed using the Statistical Package for the Social Sciences (SPSS). Men (median age, 62 years) were significantly older (z = -2.64, p = 0.008) than the women (55 years). The median duration of DM was: men, seven years; women: 10.5 years. Sixty-nine per cent were being treated with insulin. Only 45reported full compliance with medications. Their median body mass index (BMI) was 29.1, (16.6-47.4) kg/m2. Eighty-one per cent were overweight or obese. Forty-six per cent described diet and/or obesity as contributing to their diabetes. Eighty-five per cent had consulted a dietitian but only 56.4reported being on a [quot ]special diet[quot ]. Only 16.5reported not taking any sugar. Self-care scores were inversely related to HbA1c(p = 0.008), BMI (p = 0.001), sugar intake (p = 0.005) and were lowest in the area of weight control and exercise. Only 23had blood glucose controlled to HbA1c < or = 6.5. In women, HbA1clevels were inversely related to compliance with medication (p = 0.004). Glycaemic control in adults with diabetes mellitus is related to their self-care practices, especially weight control, exercise and medication compliance.

Las prácticas apropiadas de autocuidado, incluyendo cumplir con los requerimientos de la nutrición y la medicación, son esenciales para el control satisfactorio de la diabetes mellitus (DM). Este estudio descriptivo evalúa las prácticas de autocuidado, y sus relaciones con el control glicémico en adultos con DM en Jamaica. Una entrevista estructurada, previamente probada, así como mediciones antropométricas, fueron llevadas a cabo en 98 mujeres y 35 hombres, seleccionados aleatoriamente de una población (n = 510) de pacientes de una clínica de adultos. La prueba HbA1c se usó como índice de control glicémico. Las puntuaciones de la práctica de autocontrol indicaron el grado de conformidad con prácticas de estilo de vida apropiadas. Los datos fueron analizados utilizando el denominado Paquete Estadístico para la Ciencias Sociales (SPSS). Los hombres (edad mediana, 62 años) eran significativamente mayores (z = -2.64, p = 0.008) que las mujeres (55 años). La duración mediana de la DM fue como sigue: los hombres, siete años; las mujeres 10.5 años. El sesenta y nueve por ciento fue tratado con insulina. Sólo el 45% reportó cumplimiento total con los medicamentos. El índice de la masa mediana de su cuerpo (BMI) fue 29.1 (16.6–47.4) kg/m. El ochenta y uno por ciento resultaró estar por encima del peso o ser obesos. El cuarenta y seis por ciento describió la dieta y/o la obesidad como factores que contribuían a su diabetes. El ochenta y cinco por ciento había consultado a un dietista, pero sólo el 56.4% reportó estar haciendo una "dieta especial". Sólo el 16.5% reportó no estar ingiriendo azúcar ninguna. Las puntuaciones de autocuidados se hallaron en proporción inversa al por ciento resultante de la prueba HbA1c% (p = 0.008), BMI (p = 0.001), ingestión de azúcar (p = 0.005) y fueron los más bajos en el área de control de peso y ejercicios. Sólo el 23% tenía la glucosa en sangre controlada en correspondencia con HbA1c # 6.5%. En las mujeres, los niveles de...

Coping with occupational stress in an accident and emergency department

Kingston Regional Hospital's Accident and Emergency Department (A&E), located in a volatile area of Kingston, Jamaica, treats 90-170 patients daily. It does so with limited staff and a potentially stressful work environment. This study explores the factors associated with occupational stress in the Department, and the coping strategies used by the doctors and nurses working there. A pre-tested self-administered questionnaire was completed by 28 (84.8) of the total population (n = 33) of health personnel working in the A&E. The participants were 15 (53.6) doctors, eight (28.6) registered nurses and five (17.8) enrolled assistant nurses. The data were analyzed using Statistical Package for the Social Sciences (SPSS) Version 7.5. Qualitative data were analyzed by sorting texts into related themes and describing the ideas of the subjects. The median age was 32 years, range 23-50 years. Median duration of employment in the A&E was three years, range 0.5-22 years. Eighteen (60) rated the A&E as [quot ]stressful[quot ]. The major sources of stress were the external environment and the amount and quality of the workload. Ninety-six per cent reported experiencing one to seven emotional and physical symptoms. Forty-six per cent also reported behavioural symptoms. The emotional, physical and behavioural symptoms of stress were associated (p < 0.05). The number of behavioural symptoms experienced was associated with age (p < 0.05). The majority (89.2) of doctors and nurses reported that they were satisfied with their jobs and had no intention of leaving their jobs within a year. This suggested the effectiveness of the reported humour, teamwork and [quot ]extracurricular[quot ] activities in buffering the effects of stress. Nurses were more likely to be [quot ]burned out[quot ] than doctors (p = 0.03). The respondents suggested increased monetary compensation, more staff and positive feedback from managers as factors which may relieve work stress. They suggested that organized counselling and stress management programmes would be useful

Compliance and blood pressure control in women with hypertension

Compliance with treatment is a fundamental prerequisite for therapeutic benefit. The aim of this study is to determine the level of knowledge of hypertension, compliance with recommended antihypertensive therapy, and current blood pressure status in women with hypertension attending a Type V health centre. A pre-tested questionnaire with 37 in-depth items was administered to 30 (37.5) women, selected by quota sampling, from a population of 80 women with hypertension, on four consecutive regular clinic days in May/June 2001. Weights and the mean of two blood pressure measurements were recorded. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 7.5. The median age and weight of the respondents was 57 years (range 36-85 years) and 80.3 kg (range 66.8-150 kg). Median duration of hypertension was five years. Fifty per cent of the sample were diabetic. The longer the patient had been hypertensive, the greater the compliance with medication (p < 0.05). Twenty per cent of non-diabetics were controlled to blood pressure < or = 140/90 mmHg and 13 of the diabetics were controlled to blood pressure < or = 135/85 mmHg. Twenty per cent reported ill effects from medication; 60 used [quot ]folk remedies[quot] such as garlic. Only 27 of patients were fully compliant with medication. Sixty per cent did no exercise, 73 did less than one hour of exercise per week. Diabetics took more exercise than non-diabetics (Z = -2.1, p < 0.05) and were more compliant with medication than non-diabetics (Z = -2.3, p < 0.05). All respondents included salt in their diets and consumed fruits and vegetables only [quot]sometimes[quot]. One third believed that hypertension could be [quot]cured[quot]. The overall median knowledge score and median compliance score were 50 (range 16.7-100) and 31 (range 13-60) respectively. This group had inadequate knowledge of hypertension, poor compliance with recommended antihypertensive therapy (JNCVI) and limited BP control. Counselling of these patients in the areas of medication, diet, exercise and weight control is recommended. Further research, using randomized samples, to inform interventions to improve the knowledge, compliance and self-care management of patients with hypertension is indicated

Impact on blood pressure control of a six-month intervention project

The aim of this study is to evaluate the impact of a six-month structured education programme on blood pressure (BP) control in patients with uncontrolled hypertension. All patients attending the Specialist Hypertension Clinic, University Hospital of the West Indies (UHWI), between January 4 and March 29, 1999, with blood pressure > 140/90 mmHg (n = 80), were randomly divided into Group 1, cases (n = 42) and Group 2, controls (n = 38). A 40-item pretested questionnaire, administered at the baseline and final visits of both groups, elicited demographic, lifestyle and knowledge data. Group 1 attended monthly structured interventions for six months. Except for diastolic blood pressure among male controls, diastolic blood pressure and systolic blood pressure were significantly reduced at the end of the intervention period (p < 0.01). Knowledge improved among the male patients (p < 0.01). Among the female patients, activity scores were significantly increased (p < 0.01), weight (p < 0.05) and BMI (p < 0.05) were significantly reduced. There were no differences in these variables among the controls. This intervention had a benefit in blood pressure control.